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NPI Code Detail

MEDICARE: JENNIFER DAMON LCSW

MEDICARE: JENNIFER DAMON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904014545VA

General Provider Information

NPI Number : 1518675081
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DAMON LCSW
Provider Business Mailing Address
First Line : 1538 TERRACE RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-2916
Country : US
Telephone Number : 315-427-8015
Fax Number :
Provider Business Practice Location Address
First Line : 707 5TH ST NE
Second Line :
City : ROANOKE
State : VA
Zip : 24016-2123
Country : US
Telephone Number : 540-966-5808
Fax Number : 540-595-9456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2022
Last Update Date : 11/14/2022

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